Delayed Hysterectomy for Placenta Percreta: Does it Reduce Need for Transfusions?
BACKGROUND AND PURPOSE:
Zuckerwise et al. (AJOG, 2020) examined the
outcomes of patients with antenatal diagnosis of placenta percreta managed with
delayed vs immediate cesarean hysterectomy
Retrospective study (2012 to 2018)
Antepartum diagnosis of severe PAS (placenta percreta/ increta) at a single academic institution
Scheduled cesarean delivery at 34–35 weeks gestation and immediate hysterectomy
Cesarean delivery and delayed hysterectomy
Intraoperative multidisciplinary decision-making | If MFM and gyn onc consider risk in a particular case to be excessive, then placenta left in situ | Decision based on the extent of parametrial invasion (intraoperative observation)
Hysterotomy using fetal surgery technique: Stay sutures placed through the uterine wall | Small hysterotomy made with electrocautery | Membranes entered | Full-thickness, running, locking chromic suture to secure the membrane to the uterine wall | Surgical stapler to extend incision | Following delivery, hysterotomy closed with a full-thickness, running, locked delayed absorbable suture
Hysterectomy was planned for 4–6 weeks after delivery with preop MRI to confirm placental regression
Demographics | Maternal comorbidities | Time to interval hysterectomy | Blood loss | Need for transfusion | UTI injury and other maternal complications | Maternal and fetal mortality rates
34 patients with severe PAS
Delayed hysterectomy: 14 patients
9 as scheduled | 5 before the scheduled date
All cases confirmed percretra
Immediate cesarean hysterectomy: 20 patients
Intraoperative assessment of resectability: 16 patients
Preoperative or intraoperative bleeding: 4 patients
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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